Montgomery County Prevention Coalition Event Request Form
Thank you for considering the Montgomery County Prevention Coalition for your next event! Please fill out the below form to request an MCPC table or representative. Responses must be submitted at least 1 month prior to your event. Someone from the MCPC will be in contact to inform you if we are able to participate.

If you have any questions about MCPC event participation, please contact Taniayah O'Quinn-Sims at to'quinn-sims@mcadamhs.org.

Thank you!
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Event Coordinator Name *
Event Coordinator Email  *
Event Contact Phone Number *
Name of Event *
Date and Time of Event *
Event Set-Up Time *
Time
:
Location of Event *
Is this an indoor or an outdoor event? *
Please share a brief description about your event and how it connects to the mission and vision of the MCPC. *
Who is the target audience for your event? *
If other, please explain the target audience:
How many people are you expecting to attend? *
Is this the first time you have put on this event? *
Please share what you would like the MCPC to do at your event (host a table, speak, volunteer, etc.) Please be sure to include any materials you would like us to bring. *
If this is a tabling event, will we need to bring our own tables and chairs? *
Where can we go to find more information about the event? Please include a website link if available.
Is there anything else we should know about the event?
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